Global pattern of cardiovascular disease management in patients with cancer and impact of COVID-19 on drug selection: IRAQ-IC-OS survey-based study

Hasan Ali Farhan; Israa Fadhil Yaseen; Mohammed Alomar; Daniel Lenihan; Susan Dent; Alexander R Lyon

doi:10.3389/fcvm.2022.979631

Global pattern of cardiovascular disease management in patients with cancer and impact of COVID-19 on drug selection: IRAQ-IC-OS survey-based study

Front Cardiovasc Med. 2022 Sep 21:9:979631. doi: 10.3389/fcvm.2022.979631. eCollection 2022.

Authors

Hasan Ali Farhan^{1

2}, Israa Fadhil Yaseen², Mohammed Alomar³, Daniel Lenihan⁴, Susan Dent⁵, Alexander R Lyon^{6

7}

Affiliations

¹ Scientific Council of Cardiology, Iraqi Board for Medical Specializations, Baghdad, Iraq.
² Baghdad Heart Center, Baghdad Teaching Hospital, Medical City, Baghdad, Iraq.
³ University of South Florida, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, United States.
⁴ International Cardio-Oncology Society, Tampa, FL, United States.
⁵ Department of Medicine, Duke Cancer Institute, Duke University, Durham, NC, United States.
⁶ National Heart and Lung Institute, Imperial College, London, United Kingdom.
⁷ Cardio-Oncology Service, Royal Brompton Hospital, London, United Kingdom.

Abstract

Background: Regional variations in cardiovascular disease (CVD) and CVD management are well known. However, there is limited information on geographical variations in the discipline of Cardio-Oncology, including both the nature of CVD in patients with cancer and its management. Furthermore, during the recent COVID-19 pandemic, CV care for patients was disrupted resulting in an unknown impact on cardio-oncology services.

Objective: The aim of this study was to identify the regional variations in the management of CVD among patients with cancer and the impact of the COVID-19 pandemic on the selection of cardiovascular drugs in cardio-oncology.

Methods: An online survey was conducted by the Iraq Chapter of the International Cardio-Oncology Society (IC-OS). The survey was shared with cardiologists and oncologists in all seven continents to identify whether regional variations exist in cardio-oncology daily practice.

Results: From April to July 2021, 140 participants responded to the survey, including cardiologists (72.9%) and oncologists (27.1%). Most of the respondents were from the Middle East (26.4%), North America (25%), Latin America and the Caribbean (25%), and Europe (20.7%). Baseline CV risk assessment in patients with cancer using the HFA/IC-OS score was reported in 75.7% of respondents (78.4% cardiologists and 68.4% oncologists). Hypertension was the most common CVD treated by the survey respondents globally (52.1%) unlike in Europe where heart failure was the most prominent CVD (51.7%). The blood pressure cutoff value to initiate hypertension management is >140/90 mmHg globally (72.9%), but in North America (48.6%) it was >130/80 mmHg. In the Middle East, 43.2% of respondents do not use cardioprotective medication. During the COVID-19 pandemic, 10.7% of respondents changed their practice, such as switching from prescribing ACEI to ARB. Apixaban is the main anticoagulant used in patients with cancer (32.9%); however, in cancer patients with COVID-19 infection, the majority used enoxaparin (31.4%).

Conclusion: More than three-quarters of cardiologists and oncologists responding to the survey are using HFA/IC-OS proformas. The survey showed regional variations in the management of CVD on different continents. The use of cardioprotective agents was limited in some regions including the Middle East. COVID-19 pandemic impacted daily practice on the selection and switching of cardiovascular drugs including ACEI/ARB and the choice of anticoagulants.

Keywords: COVID-19; anticoagulant; cardio-oncology; cardiovascular disease; heart failure; hypertension.